section name header

Drug Name ⬇

acetylcysteine (Rx)

(a-se-teel-sis'tay-een)

Acetadote

Func. class.: Mucolytic; antidote-acetaminophen

Chem. class.: Amino acid l-cysteine

Do not confuse:

acetylcysteine/acetylcholine

Action ⬆ ⬇

Decreases viscosity of secretions by breaking disulfide links of mucoproteins; serves as a substrate in place of glutathione, which is necessary to inactivate toxic metabolites with acetaminophen overdose

Uses ⬆ ⬇

Acetaminophen toxicity; bronchitis; cystic fibrosis; COPD; atelectasis

Contraindications ⬆ ⬇

Hypersensitivity

Precautions: Pregnancy, breastfeeding, hypothyroidism, Addison's disease, CNS depression, brain tumor, asthma, renal/hepatic disease, COPD, psychosis, alcoholism, seizure disorders, bronchospasms, anaphylactoid reactions, fluid restriction, weight <40 kg, increased intracranial pressure, status asthmaticus

Dosage and Routes ⬆ ⬇

Acetaminophen toxicity

  • Adult and child:≥41-100 kg IV loading dose 150 mg/kg over 60 min (dilution 150 mg/kg in 200 mL of D5W); then 50 mg/kg over 4 hr (dilution 50 mg/kg in 500 mL D5W); then 100 mg/kg over 16 hr (dilution 100 mg/kg in 1000 mL D5W)

  • Adult/child 21-40 kg: IV 150 mg/kg in 100 mL diluent over 1 hr, then 50 mg/kg in 250 mL over 4 hr, then 100 mg/kg in 500 mL over 16 hr

  • Infant/child 5-20 kg: IV 150 mg/kg in 3 mL/kg diluent over 1 hr, then 50 mg/kg in 7 mL/kg diluent over 4 hr, then 100 mg/kg in 14 mL/kg diluent over 16 hr

Bronchopulmonary disease (mucolytic)

  • Give bronchodialators 15 min before acetylsteine

  • Adult and child 1-12 yr: INSTILL 1-2 mL (10%-20% solution) q2-6hr prn or 3-5 mL (20°% solution) or 6-10 mL (10°% sol) tid or qid; NEBULIZER (face mask, mouthpiece, tracheostomy) 1-10 mL of a 20% sol, or 2-20 mL of a 10% sol, q2-8hr; NEBULIZER (tent, croupette) may require large dose, up to 300 mL/treatment

Tracheostomy care

  • Adult/child: INSTILL 1-2 mL (10%-20% sol) q1-4hr directly into tracheostomy

Diagnostic bronchial lab studies

  • Adult/child: NEBULIZER 2-3 uses of 1-2 mL of 20% sol or 2-4 mL of 10% sol

Available forms:Inhalation solution 10%, 20%; inj 20% (200 mg/mL)

Administer:

Direct intratracheal instill route

  • By syringe: 1-2 mL of 10%-20% solution up to q1hr

  • Decreased dose to geriatric patients; metabolism may be slowed

  • Only if suction machine is available

  • Only after patient clears airway by deep breathing, coughing

  • Assistance with inhaled dose: bronchodilator if bronchospasm occurs; mechanical suction if cough insufficient to remove excess bronchial secretions

IV route

  • 21-hr regimen: loading dose: dilute 150 mg/kg in 200 mL D5W; maintenance dose 1: dilute 50 mg/kg in 500 mL D5W; maintenance dose 2: dilute 100 mg/kg in 1000 mL D5W; give loading dose over 15 min; give maintenance dose 1 over 4 hr; give maintenance dose 2 over 16 hr, administer sequentially without time between doses

  • Store in refrigerator; use within 96 hr of opening

Side Effects ⬆ ⬇

CNS:Dizziness, drowsiness,fever, chills

CV:Edema, flushing tachycardia

EENT:Rhinorrhea,pharyngitis

GI:Nausea, stomatitis, vomiting, anorexia

INTEG:Urticaria, rash, clamminess, pruritus

RESP: Bronchospasm, chest tightness, cough, dyspnea

MISC:Anaphylaxis, angioedema, unpleasant odor

Side effects: italics = common; red = life-threatening

Pharmacokinetics ⬆ ⬇

IV: Excreted in urine, half-life 5.6 hr (adult), 11 hr (newborn), protein binding 83%, peak 5-10 min (INH)

Nursing Considerations ⬆

Assess:

  • Mucolytic use: cough-type, frequency, character, including sputum; bronchospasm

  • Rate, rhythm of respirations, increased dyspnea; sputum

  • VS, cardiac status including checking for dysrhythmias, increased rate, palpitations

  • Labs: ABGs for increased CO2 retention in asthma patients

  • Antidotal use: use within 24 hr of acetaminophen toxicity, give within 10 hr of acetaminophen to minimize hepatotoxicity; monitor LFTs, PT, BUN, creatinine, glucose, electrolytes, acetaminophen levels; inform prescriber if dose is vomited or if vomiting is persistent; 150 mg/kg may be toxic, check acetaminophen level q4hr

  • Bronchospasm: discontinue, notify health care provider if bronchospasm occurs

  • Hypersensitivity: anaphylaxis may occur with IV dose; if present, stop infusion, treat, restart; assess for dyspnea, swelling of face, lips, tongue; rash, itching

  • Nausea, vomiting, rash; notify prescriber if these occur

  • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breastfeeding, excretion unknown

Evaluate:

  • Therapeutic response: absence of purulent secretions when coughing, clear lung sounds (mucolytic use); absence of hepatic damage with acetaminophen toxicity

Teach patient/family:

  • That foul odor and smell may be unpleasant

  • To clear airway for inhalation

  • To report vomiting because dose may need to be repeated

  • Provide adequate hydration

  • Teach coughing and deep breathing

  • Acetaminophen toxicity: Explain reason for product, expected result